NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2912A
SPONSOR: Paulin (MS)
 
TITLE OF BILL:
An act to amend the public health law, in relation to requiring immuni-
zation against human papillomavirus (HPV)
 
SUMMARY OF SPECIFIC PROVISIONS::
Section one of this bill amends section 2164 of the Public Health Law to
require persons in parental relation to children born on or after Janu-
ary 1, 2009 who are entering or have entered seventh grade or a compara-
ble age level special education program on or after September 1st, 2021
to have administered to such children an adequate dose or doses of
immunizing agents against human papillomavirus (HPV).
Section two of this bill makes conforming changes to ensure that the
changes that section one of this bill makes to subdivision 7 of section
2164 of the Public Health Law remain in effect after certain provisions
of such subdivision are repealed in 2020.
Section three of this bill amends paragraph (a) of subdivision 1 of
section 613 of the public health law by adding HPV to the list of commu-
nicable diseases against which the commissioner of health shall develop
and supervise the execution of a program of immunization, surveillance
and testing in order to raise to the highest reasonable level the immu-
nity of children in the state.
Section four provides the effective date, and specifies that the changes
made by sections one and two of this bill only apply to children born on
or after January 1, 2009.
 
JUSTIFICATION::
Human papillomavirus (HPV) is an incredibly common sexually transmitted
infection (STI) that can be passed even when an infected person is
asymptomatic, and can cause genital warts or cancer. The Centers for
Disease Control and Prevention (CDC) estimates that 79 million Americans
are infected with HPV, most of whom are in their late teens and early
twenties. The American Cancer Society (ACS) estimates that four out of
five people will get HPV at some point in their lives.
According to the CDC, HPV causes nearly 35,000 new cases of cancer each
year in the U.S. in both men and women (About 20,700 cases in women and
14,100 cases in men), on parts of the body including the cervix, vagina,
vulva, penis, anus, rectum, and oropharynx.
The CDC also notes that in 2016 (the most recent year for which data is
available), 12,984 new cases of cervical cancer were reported in the
U.S., and approximately 4,188 women died of cervical cancer. In New
York State, there were 824 cases of cervical cancer and 264 related
deaths in 2016.
The World Health Organization (WHO) notes that cervical cancer is "the
fourth most frequent cancer in women with an estimated 570,000 new cases
in 2018 representing 6.6% of all female cancers."
According to the ACS, 99.7% of all cervical cancer cases are linked to
HPV. The ACS estimates that at least 80% of sexually active women in the
United States will have HPV by age 50, with most cases acquired soon
after individuals have sex for the first time. While the majority of
cases resolve on their own, for women whose body defenses are not suffi-
cient to clear the virus, cervical cancer can develop later in life, as
it can take up to 20 years for an HPV infection to cause cervical
cancer.
In summation, HPV infection is widespread, and poses real dangers and
health risks for both men and women. Thankfully, there is an immediate
solution to this problem. The CDC estimates that routine vaccination
could prevent 92% of cancers caused by HPV, saving thousands of lives.
ACS, the WHO, and countless other public health experts concur that
routine vaccination is one of our best defenses against HPV - caused
cancers and infections.
The CDC's Advisory Committee on Immunization Practices (ACIP) recommends
routine vaccination against HPV for both girls and boys 11-12 years of
age, though the vaccine can be given to children as young as 9 years old
in cases where such children have a history of sexual abuse or a ssault.
This is because the vaccine is most effective when it is administered
prior to its recipient becoming sexually active.
According to the CDC, each vaccine against HPV that the FDA has licensed
for use went through "years of extensive safety testing" and was found
to be safe and effective in clinical trials. More than a decade after
the first HPV vaccine was approved for use, studies and meta-analyses of
currently available data continue to show that the HPV vaccine is safe,
and has resulted in compelling public health benefits and significantly
decreased rates of HPV prevalence and new diagnoses.
In fact, a comprehensive study published by Australian public health
officials in 2017 outlined the extensive benefits of prophylactic HPV
vaccination programs and recommended that "all countries consider and
promote national guidelines and programs to prevent HPV-related
diseases." Australia was one of the first countries to implement a
school-based HPV vaccination program, and has seen a drop of up to 86%
in the prevalence of HPV infections among those receiving the vaccine.
This bill would require all children born on or after January 1, 2009
who are entering or have entered the seventh grade in New York State on
or after September 1, 2021 to receive the HPV vaccine in order to attend
school. School-based requirements are one of the most effective ways to
ensure comprehensive immunization coverage in a society, and it is well
within the purview of New York State government to act proactively in
this matter to protect public health and prevent future cancer diag-
noses. This approach also has precedent in the United States, as Virgi-
nia, Rhode Island, and the District of Columbia currently require
students to be vaccinated against HPV in order to attend school, and
Hawaii will join them starting in the summer of 2020. Legislation to
require this practice is also currently pending in at least seven other
states.
 
PRIOR LEGISLATIVE HISTORY::
A.933, 2017 and 2018, referred to health.
A.1822, 2016 and 2017 referred to health.
A.2067, 2013 and 2014 referred to health.
A.699, 2011 and 2012 referred to health.
A.778, 2009 and 2010 referred to health.
A.5810, 2007 and 2008 referred to health.
 
FISCAL IMPLICATION::
Minimal to the State, offset by future healthcare costs related to the
treatment of cervical cancer and other cancers caused by HPV.
 
EFFECTIVE DATE::
This act shall take effect on September 1, 2021.
STATE OF NEW YORK
________________________________________________________________________
2912--A
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
___________
Introduced by M. of A. PAULIN, GUNTHER, ORTIZ -- Multi-Sponsored by --
M. of A. DINOWITZ, LIFTON -- read once and referred to the Committee
on Health -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the public health law, in relation to requiring immuni-
zation against human papillomavirus (HPV)
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 2164 of the public health law, as amended by chap-
2 ter 401 of the laws of 2015, subdivisions 6 and 7 as amended by chapter
3 35 of the laws of 2019, is amended to read as follows:
4 § 2164. Definitions; immunization against poliomyelitis, mumps,
5 measles, diphtheria, rubella, varicella, Haemophilus influenzae type b
6 (Hib), pertussis, tetanus, pneumococcal disease, meningococcal disease,
7 [and] hepatitis B and human papillomavirus (HPV). 1. As used in this
8 section, unless the context requires otherwise:
9 a. The term "school" means and includes any public, private or paro-
10 chial child caring center, day nursery, day care agency, nursery school,
11 kindergarten, elementary, intermediate or secondary school.
12 b. The term "child" shall mean and include any person between the ages
13 of two months and eighteen years.
14 c. The term "person in parental relation to a child" shall mean and
15 include his father or mother, by birth or adoption, his legally
16 appointed guardian, or his custodian. A person shall be regarded as the
17 custodian of a child if he has assumed the charge and care of the child
18 because the parents or legally appointed guardian of the minor have
19 died, are imprisoned, are mentally ill, or have been committed to an
20 institution, or because they have abandoned or deserted such child or
21 are living outside the state or their whereabouts are unknown, or have
22 designated the person pursuant to title fifteen-A of article five of the
23 general obligations law as a person in parental relation to the child.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03954-10-9
A. 2912--A 2
1 d. The term "health practitioner" shall mean any person authorized by
2 law to administer an immunization.
3 2. a. Every person in parental relation to a child in this state shall
4 have administered to such child an adequate dose or doses of an immuniz-
5 ing agent against poliomyelitis, mumps, measles, diphtheria, rubella,
6 varicella, Haemophilus influenzae type b (Hib), pertussis, tetanus,
7 pneumococcal disease, and hepatitis B, which meets the standards
8 approved by the United States public health service for such biological
9 products, and which is approved by the department under such conditions
10 as may be specified by the public health and health planning council.
11 b. Every person in parental relation to a child in this state born on
12 or after January first, nineteen hundred ninety-four and entering sixth
13 grade or a comparable age level special education program with an unas-
14 signed grade on or after September first, two thousand seven, shall have
15 administered to such child a booster immunization containing diphtheria
16 and tetanus toxoids, and an acellular pertussis vaccine, which meets the
17 standards approved by the United States public health service for such
18 biological products, and which is approved by the department under such
19 conditions as may be specified by the public health and health planning
20 council.
21 c. Every person in parental relation to a child in this state entering
22 or having entered seventh grade and twelfth grade or a comparable age
23 level special education program with an unassigned grade on or after
24 September first, two thousand sixteen, shall have administered to such
25 child an adequate dose or doses of immunizing agents against meningococ-
26 cal disease as recommended by the advisory committee on immunization
27 practices of the centers for disease control and prevention, which meets
28 the standards approved by the United States public health service for
29 such biological products, and which is approved by the department under
30 such conditions as may be specified by the public health and health
31 planning council.
32 d. Every person in parental relation to a child in this state entering
33 or having entered seventh grade or a comparable age level special educa-
34 tion program with an unassigned grade on or after September first, two
35 thousand twenty-one, shall have administered to such child an adequate
36 dose or doses of immunizing agents against human papillomavirus (HPV) as
37 recommended by the advisory committee on immunization practices of the
38 centers for disease control and prevention, which meets the standards
39 approved by the United States public health service for such biological
40 products, and which is approved by the department under such conditions
41 as may be specified by the public health and health planning council.
42 3. The person in parental relation to any such child who has not
43 previously received such immunization shall present the child to a
44 health practitioner and request such health practitioner to administer
45 the necessary immunization against poliomyelitis, mumps, measles,
46 diphtheria, Haemophilus influenzae type b (Hib), rubella, varicella,
47 pertussis, tetanus, pneumococcal disease, meningococcal disease, [and]
48 hepatitis B and human papillomavirus (HPV) as provided in subdivision
49 two of this section.
50 4. If any person in parental relation to such child is unable to pay
51 for the services of a private health practitioner, such person shall
52 present such child to the health officer of the county in which the
53 child resides, who shall then administer the immunizing agent without
54 charge.
55 5. The health practitioner who administers such immunizing agent
56 against poliomyelitis, mumps, measles, diphtheria, Haemophilus influen-
A. 2912--A 3
1 zae type b (Hib), rubella, varicella, pertussis, tetanus, pneumococcal
2 disease, meningococcal disease, [and] hepatitis B and human papillomavi-
3 rus (HPV) to any such child shall give a certificate of such immuniza-
4 tion to the person in parental relation to such child.
5 6. In the event that a person in parental relation to a child makes
6 application for admission of such child to a school or has a child
7 attending school and there exists no certificate or other acceptable
8 evidence of the child's immunization against poliomyelitis, mumps,
9 measles, diphtheria, rubella, varicella, hepatitis B, pertussis, teta-
10 nus, and, where applicable, Haemophilus influenzae type b (Hib), menin-
11 gococcal disease, [and] pneumococcal disease and human papillomavirus
12 (HPV), the principal, teacher, owner or person in charge of the school
13 shall inform such person of the necessity to have the child immunized,
14 that such immunization may be administered by any health practitioner,
15 or that the child may be immunized without charge by the health officer
16 in the county where the child resides, if such person executes a consent
17 therefor. In the event that such person does not wish to select a health
18 practitioner to administer the immunization, he or she shall be provided
19 with a form which shall give notice that as a prerequisite to processing
20 the application for admission to, or for continued attendance at, the
21 school such person shall state a valid reason for withholding consent or
22 consent shall be given for immunization to be administered by a health
23 officer in the public employ, or by a school physician or nurse. The
24 form shall provide for the execution of a consent by such person and it
25 shall also state that such person need not execute such consent if
26 subdivision eight of this section applies to such child.
27 7. (a) No principal, teacher, owner or person in charge of a school
28 shall permit any child to be admitted to such school, or to attend such
29 school, in excess of fourteen days, without the certificate provided for
30 in subdivision five of this section or some other acceptable evidence of
31 the child's immunization against poliomyelitis, mumps, measles, diphthe-
32 ria, rubella, varicella, hepatitis B, pertussis, tetanus, and, where
33 applicable, Haemophilus influenzae type b (Hib), meningococcal disease,
34 [and] pneumococcal disease and human papillomavirus (HPV); provided,
35 however, such fourteen day period may be extended to not more than thir-
36 ty days for an individual student by the appropriate principal, teacher,
37 owner or other person in charge where such student is transferring from
38 out-of-state or from another country and can show a good faith effort to
39 get the necessary certification or other evidence of immunization or
40 where the parent, guardian, or any other person in parental relationship
41 to such child can demonstrate that a child has received at least the
42 first dose in each immunization series required by this section and has
43 age appropriate appointments scheduled to complete the immunization
44 series according to the Advisory Committee on Immunization Practices
45 Recommended Immunization Schedules for Persons Aged 0 through 18 Years.
46 (b) A parent, a guardian or any other person in parental relationship
47 to a child denied school entrance or attendance may appeal by petition
48 to the commissioner of education in accordance with the provisions of
49 section three hundred ten of the education law.
50 8. If any physician licensed to practice medicine in this state certi-
51 fies that such immunization may be detrimental to a child's health, the
52 requirements of this section shall be inapplicable until such immuniza-
53 tion is found no longer to be detrimental to the child's health.
54 8-a. Whenever a child has been refused admission to, or continued
55 attendance at, a school as provided for in subdivision seven of this
56 section because there exists no certificate provided for in subdivision
A. 2912--A 4
1 five of this section or other acceptable evidence of the child's immuni-
2 zation against poliomyelitis, mumps, measles, diphtheria, rubella, vari-
3 cella, hepatitis B, pertussis, tetanus, and, where applicable, Haemophi-
4 lus influenzae type b (Hib), meningococcal disease, [and] pneumococcal
5 disease and human papillomavirus (HPV), the principal, teacher, owner or
6 person in charge of the school shall:
7 a. forward a report of such exclusion and the name and address of such
8 child to the local health authority and to the person in parental
9 relation to the child together with a notification of the responsibility
10 of such person under subdivision two of this section and a form of
11 consent as prescribed by regulation of the commissioner, and
12 b. provide, with the cooperation of the appropriate local health
13 authority, for a time and place at which an immunizing agent or agents
14 shall be administered, as required by subdivision two of this section,
15 to a child for whom a consent has been obtained. Upon failure of a local
16 health authority to cooperate in arranging for a time and place at which
17 an immunizing agent or agents shall be administered as required by
18 subdivision two of this section, the commissioner shall arrange for such
19 administration and may recover the cost thereof from the amount of state
20 aid to which the local health authority would otherwise be entitled.
21 10. The commissioner may adopt and amend rules and regulations to
22 effectuate the provisions and purposes of this section.
23 11. Every school shall annually provide the commissioner, on forms
24 provided by the commissioner, a summary regarding compliance with the
25 provisions of this section.
26 § 2. Subdivision 7 of section 2164 of the public health law, as
27 amended by chapter 401 of the laws of 2015, is amended to read as
28 follows:
29 7. (a) No principal, teacher, owner or person in charge of a school
30 shall permit any child to be admitted to such school, or to attend such
31 school, in excess of fourteen days, without the certificate provided for
32 in subdivision five of this section or some other acceptable evidence of
33 the child's immunization against poliomyelitis, mumps, measles, diphthe-
34 ria, rubella, varicella, hepatitis B, pertussis, tetanus, and, where
35 applicable, Haemophilus influenzae type b (Hib), meningococcal disease,
36 [and] pneumococcal disease and human papillomavirus (HPV); provided,
37 however, such fourteen day period may be extended to not more than thir-
38 ty days for an individual student by the appropriate principal, teacher,
39 owner or other person in charge where such student is transferring from
40 out-of-state or from another country and can show a good faith effort to
41 get the necessary certification or other evidence of immunization.
42 (b) A parent, a guardian or any other person in parental relationship
43 to a child denied school entrance or attendance may appeal by petition
44 to the commissioner of education in accordance with the provisions of
45 section three hundred ten of the education law.
46 § 3. Paragraph (a) of subdivision 1 of section 613 of the public
47 health law, as amended by section 24 of part E of chapter 56 of the laws
48 of 2013, is amended to read as follows:
49 (a) The commissioner shall develop and supervise the execution of a
50 program of immunization, surveillance and testing, to raise to the high-
51 est reasonable level the immunity of the children of the state against
52 communicable diseases including, but not limited to, influenza, poliom-
53 yelitis, measles, mumps, rubella, haemophilus influenzae type b (Hib),
54 diphtheria, pertussis, tetanus, varicella, hepatitis B, pneumococcal
55 disease, human papillomavirus (HPV), and the immunity of adults of the
56 state against diseases identified by the commissioner, including but not
A. 2912--A 5
1 limited to influenza, smallpox, hepatitis and such other diseases as the
2 commissioner may designate through regulation. Municipalities in the
3 state shall maintain local programs of immunization to raise the immuni-
4 ty of the children and adults of each municipality to the highest
5 reasonable level, in accordance with an application for state aid
6 submitted by the municipality and approved by the commissioner. Such
7 programs shall include assurance of provision of vaccine, serological
8 testing of individuals and educational efforts to inform health care
9 providers and target populations or their parents, if they are minors,
10 of the facts relative to these diseases and immunizations to prevent
11 their occurrence.
12 § 4. This act shall take effect on September 1, 2021; provided, howev-
13 er, that:
14 a. sections one and two of this act shall apply only to children born
15 on or after January 1, 2009; and
16 b. the amendments to subdivision 7 of section 2164 of the public
17 health law made by section one of this act shall be subject to the expi-
18 ration and reversion of such subdivision pursuant to section 4 of chap-
19 ter 35 of the laws of 2019 when upon such date the provisions of section
20 two of this act shall take effect.
21 Effective immediately the addition, amendment and/or repeal of any
22 rule or regulation necessary for the implementation of this act on its
23 effective date are authorized to be made and completed on or before such
24 date.